【摘要】 目的研究腹腔镜胆囊切除术 (laparoscopiccholecystectomy ,LC)后肩部疼痛发生的原因、机理及防治方法。方法将 12 0例行LC的患者随机分为A、B、C组 ,每组 4 0例。气腹压力设定A组 10mmHg ,B组 12mmHg ,C组 14mmHg。观察 3组术前、术后的PaO2 、PaCO2 、动脉血 pH值以及术后 1、3、6、12、2 4、4 8、72、96h肩痛的发生率和疼痛程度 (视觉模拟评分 VAS)。结果术中CO2 用量C组较A组多 ,差异有显著意义 (F =11 38,P <0 0 5 )。C组术前、术后的PaO2 差值与A、B组术前、术后PaO2 差值相比较大 ,且差异有显著意义 (F =6 92 ,P <0 0 1)。随 3组气腹压力的增高 ,术后 3、12、2 4、4 8h肩痛发生率有增高趋势 (χ2 值分别为 2 36 6 ,2 32 4 ,2 72 9,2 340 ,P <0 0 5 ) ;其VAS评分也明显上升 (F =19 5 3,P <0 0 1)。结论LC术后肩痛的主要原因可能与人工气腹张力对膈肌的牵拉有关。在 10mmHg低压气腹下行LC ,可显著降低LC术后肩痛的发生率及疼痛程度。更多还原

【Abstract】 Objective To determine if the carbon dioxide (CO 2) pressure used in laparoscopic cholecystectomy (LC) has any effect on the occurrence of postoperative shoulder pain. Methods One hundred and twenty consecutive patients undergoing LC were prospectively divided into three groups(40 patients in each group): Patients in group A underwent LC with 10 mm Hg of CO 2, those in group B with 12 mm Hg of CO 2, and in group C with 14 mm Hg of CO 2. PaO 2?PaCO 2?pH before and after LC were recorded. Shoulder pain was recorded on a visual analogue pain scale 1,3,6,12,24,48,72,96 h after operation. Results The intraoperative CO 2 consumption was significantly higher in group C (F=11.38,P<0.05) than in group A. The PaO 2 difference in group C before and after LC was significantly larger than in group A and B(F=6.92,P<0.01). Postoperative shoulder pain rate at 3,12,24,48 h increased significantly with the increase of CO 2 pressure(χ 2=2.366,χ 2=2.324,χ 2=2.729,χ 2=2.340, P<0.05). Mean shoulder pain scores also significantly increased (F=19.53,P<0.001). ConclusionThe over-streching of the superior hepatic ligaments due to CO 2 insufflation are probably the main cause of post LC shoulder pain. A 10 mm Hg CO 2 pneumoperitoneum helps to reduce the occurrence of post LC shoulder pain.更多还原